J Orthop Sports Phys Ther. 2017 Jun;47(6):392-401. doi: 10.2519/jospt.2017.7389. Epub 2017 May 13.
Study Design Randomized controlled trial. Background Evidence suggests that multimodal interventions that include exercise therapy may be effective for patellofemoral pain (PFP); however, no study has investigated the effects of trigger point (TrP) dry needling (DN) in people with PFP. Objectives To compare the effects of adding TrP DN to a manual therapy and exercise program on pain, function, and disability in individuals with PFP. Methods Individuals with PFP (n = 60) recruited from a public hospital in Valencia, Spain were randomly allocated to manual therapy and exercises (n = 30) or manual therapy and exercise plus TrP DN (n = 30). Both groups received the same manual therapy and strengthening exercise program for 3 sessions (once a week for 3 weeks), and 1 group also received TrP DN to active TrPs within the vastus medialis and vastus lateralis muscles. The pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS; 0-100 scale) was used as the primary outcome. Secondary outcomes included other subscales of the KOOS, the Knee Society Score, the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), and the numeric pain-rating scale. Patients were assessed at baseline and at 15-day (posttreatment) and 3-month follow-ups. Analysis was conducted with mixed analyses of covariance, adjusted for baseline scores. Results At 3 months, 58 subjects (97%) completed the follow-up. No significant between-group differences (all, P>.391) were observed for any outcome: KOOS pain subscale mean difference, -2.1 (95% confidence interval [CI]: -4.6, 0.4); IKDC mean difference, 2.3 (95% CI: -0.1, 4.7); knee pain intensity mean difference, 0.3 (95% CI: -0.2, 0.8). Both groups experienced similar moderate-to-large within-group improvements in all outcomes (standardized mean differences of 0.6 to 1.1); however, only the KOOS function in sport and recreation subscale surpassed the prespecified minimum important change. Conclusion The current clinical trial suggests that the inclusion of 3 sessions of TrP DN in a manual therapy and exercise program did not result in improved outcomes for pain and disability in individuals with PFP at 3-month follow-up. Level of Evidence Therapy, level 1b. Prospectively registered July 27, 2015 at www.clinicaltrials.gov (NCT02514005). J Orthop Sports Phys Ther 2017;47(6):392-401. doi:10.2519/jospt.2017.7389.
随机对照试验。背景：有证据表明，包含运动疗法的多模式干预可能对髌股疼痛（PFP）有效；然而，尚无研究调查触发点（TrP）干针（DN）在 PFP 患者中的效果。目的：比较在手动治疗和运动方案中添加 TrP DN 对 PFP 患者疼痛、功能和残疾的影响。方法：从西班牙巴伦西亚的一家公立医院招募 PFP 患者（n = 60），并将其随机分配至手动治疗和运动组（n = 30）或手动治疗和运动加 TrP DN 组（n = 30）。两组均接受 3 次（每周 1 次，持续 3 周）相同的手动治疗和强化运动方案，并且 1 组还接受 TrP DN 治疗股直肌和股外侧肌内的活动 TrP。Knee injury and Osteoarthritis Outcome Score（KOOS；0-100 量表）的疼痛亚量表被用作主要结局。次要结局包括 KOOS 的其他亚量表、膝关节协会评分、国际膝关节文献委员会主观膝关节评估表（IKDC）和数字疼痛评分量表。患者在基线和 15 天（治疗后）和 3 个月随访时进行评估。分析采用混合协方差分析，根据基线评分进行调整。结果：在 3 个月时，58 名受试者（97%）完成了随访。任何结局均未观察到组间的显著差异（均，P>.391）：KOOS 疼痛亚量表平均差异，-2.1（95%置信区间[CI]：-4.6，0.4）；IKDC 平均差异，2.3（95% CI：-0.1，4.7）；膝关节疼痛强度平均差异，0.3（95% CI：-0.2，0.8）。两组在所有结局中均经历了类似的中等至较大的组内改善（标准化平均差异为 0.6 至 1.1）；然而，只有 KOOS 运动和娱乐功能亚量表的改善超过了预设的最小重要变化。结论：目前的临床试验表明，在手动治疗和运动方案中加入 3 次 TrP DN 并不能在 3 个月随访时改善 PFP 患者的疼痛和残疾结局。证据水平：治疗，1b 级。2015 年 7 月 27 日在 www.clinicaltrials.gov 进行前瞻性注册（NCT02514005）。J Orthop Sports Phys Ther 2017;47(6):392-401. doi:10.2519/jospt.2017.7389.
